Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Pennsylvania

Medicaid work requirements in Pennsylvania: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Pennsylvania expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 769,099 of them (10.1% of an expansion pool of 822,177) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 217,271 people in Pennsylvania lose coverage by 2034: 194,198 of them still eligible but lost to paperwork and reporting failures, and 23,073 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Pennsylvania scores 41 of 100 on this model's ex parte capability index, a high band; its eligibility system is COMPASS.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasurePennsylvania
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)822,177
Adults subject, strict definition769,099
Adults subject, permissive definition753,717
Share of expansion pool subject10.1%
Projected coverage loss by 2034217,271
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)41 (high)

Who is subject in Pennsylvania

Of the 769,098 subject adults, 37% already work 80 or more hours a month and 56% are not working. 35% have a child under 14 at home. Among those not working, 52% report a disability and 15% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2413%
Age 25-3422%
Age 35-4421%
Age 45-5418%
Age 55-6426%
Not working56%
1 to 19 hours a month1%
20 to 79 hours a month6%
80 or more hours a month (meets the bar)37%
Not working: Disabled52%
Not working: Caregiver15%
Not working: Postpartum0%
Not working: Student2%
Not working: Other30%

Why eligible people lose coverage

Of the 217,271 projected to lose coverage in Pennsylvania, 194,198 meet the requirement or qualify for an exemption but fail to document it. 93,994 of those are working people who cannot prove their hours through data the state can see, and 100,204 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work27,342
Multiple part-time jobs (aggregation failure)20,031
Self-employed (other)18,990
Full-time students not auto-verified7,011
Volunteering / job training6,808
Cash-paid construction & trades6,402
Seasonal: agriculture, hospitality, food service4,383
Gig / courier (DoorDash, Uber, Lyft, Instacart)3,027
Medically frail without auto-match42,645
Caregivers of a disabled adult27,345
Parent caregivers of children ≤13 without auto-match9,397
American Indian / Alaska Native (tribal exemption)6,298
SUD treatment not flagged in claims data5,927
Kinship caregivers (non-parent) of children ≤135,047
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)1,986
Recent incarceration (data-match gap)1,204
Pregnancy / postpartum data lag356

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (16% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Pennsylvania's composite score is 41 (high band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite41
Observed ex parte16
Core capability81
Data sources72
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four266,89234.7%
Medically frail131,11717.1%
Working ≥ qualifying hours / income127,45916.6%
Working ≥ qualifying hours / income + Parent caregiver of child ≤13117,72815.3%
Parent caregiver of child ≤1351,1996.7%
Full-time student21,3332.8%
Working ≥ qualifying hours / income + Full-time student15,9642.1%
Working ≥ qualifying hours / income + Medically frail12,4561.6%

Counties in Pennsylvania

Subject adults concentrate: Philadelphia County (79,040), Allegheny County (71,523), and Montgomery County (49,807) account for 26% of the state's subject population.

All 67 counties in Pennsylvania with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Philadelphia County79,0408.0%22,32923.0%988,458
Allegheny County71,5239.7%20,20511.0%741,004
Montgomery County49,8079.8%14,0716.0%509,570
Bucks County39,88810.5%11,2686.0%378,648
Delaware County33,5559.8%9,47910.0%341,229
Lancaster County33,55110.8%9,4788.0%312,164
Chester County32,60510.1%9,2116.0%321,986
York County27,29810.1%7,7129.0%269,270
Berks County25,88710.2%7,31312.0%253,056
Westmoreland County22,27611.2%6,29310.0%199,156
Lehigh County21,8179.8%6,16312.0%222,468
Northampton County20,35310.9%5,7509.0%187,031
Luzerne County18,9909.9%5,36515.0%191,207
Erie County16,42610.5%4,64015.0%155,878
Dauphin County16,3519.7%4,61912.0%169,429
Cumberland County15,6759.9%4,4288.0%157,674
Lackawanna County12,88710.4%3,64113.0%124,423
Washington County12,79910.6%3,6169.0%120,382
Centre County12,27111.9%3,46717.0%102,968
Butler County12,17110.5%3,4388.0%115,530
Monroe County10,73210.7%3,03211.0%100,403
Beaver County10,11510.7%2,85710.0%94,836
Franklin County9,34110.4%2,6399.0%89,391
Lebanon County8,72910.8%2,46611.0%80,446
Schuylkill County8,47110.2%2,39312.0%83,335
Cambria County8,40911.5%2,37614.0%72,964
Fayette County7,38710.3%2,08716.0%72,066
Blair County7,27510.6%2,05513.0%68,897
Adams County7,03011.6%1,9868.0%60,568
Lycoming County6,91210.6%1,95312.0%65,133
Mercer County6,77511.0%1,91414.0%61,794
Indiana County5,73511.8%1,62013.0%48,580
Northumberland County5,42210.5%1,53212.0%51,730
Crawford County5,27211.5%1,48913.0%45,841
Lawrence County5,22011.1%1,47512.0%47,146
Clearfield County4,69910.1%1,32714.0%46,449
Somerset County4,40210.6%1,24411.0%41,530
Columbia County4,18610.7%1,18215.0%38,978
Carbon County4,18011.1%1,18112.0%37,577
Armstrong County4,09811.3%1,15810.0%36,312
Pike County4,06511.7%1,14810.0%34,880
Bradford County3,75411.5%1,06113.0%32,656
Wayne County3,30511.3%93411.0%29,328
Venango County3,14011.4%88713.0%27,536
Bedford County2,98511.3%84311.0%26,432
Perry County2,84910.7%8058.0%26,614
Mifflin County2,74110.9%77417.0%25,040
Jefferson County2,70011.1%76314.0%24,304
Tioga County2,66111.7%75212.0%22,707
Union County2,63910.4%74611.0%25,374
Huntingdon County2,60710.2%73711.0%25,570
Snyder County2,58411.5%7308.0%22,486
Susquehanna County2,49611.8%70511.0%21,068
McKean County2,44610.6%69114.0%23,153
Clinton County2,41811.0%68313.0%21,912
Warren County2,40311.6%67912.0%20,757
Clarion County2,39211.1%67614.0%21,583
Greene County2,06410.0%58313.0%20,544
Elk County2,02511.8%5729.0%17,079
Wyoming County1,73211.8%48911.0%14,675
Juniata County1,45411.2%4119.0%13,024
Potter County1,04312.1%29512.0%8,608
Montour County9789.4%2769.0%10,356
Fulton County93411.4%26411.0%8,206
Sullivan County42512.8%12012.0%3,330
Forest County4068.5%11519.0%4,758
Cameron County29212.5%8215.0%2,328

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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